MEDICARE: DR. WILLIAM C SANDERSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	10084	NY

General Provider Information

NPI Number	:	1083765432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM C SANDERSON PHD

Provider Business Mailing Address
First Line	:	11 MIDDLE NECK RD
Second Line	:	SUITE 207
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2301
Country	:	US
Telephone Number	:	516-466-8485
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MIDDLE NECK RD
Second Line	:	SUITE 207
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2301
Country	:	US
Telephone Number	:	516-466-8485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/08/2007

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